Program Forms

REMINDER: As per USDA, the Program Forms should be distributed on or about the beginning of the school year, no more than 30 days prior.

Operational Forms

Form Name Format
Requesting Common Logon Permissions for NSLP/Direct Certification PDF
Health and Nutrition Services Entity Data Form (ADD/CHANGE/DELETE) PDF
Food Program Permanent Service Agreement (2 originals must be submitted for ADE approval) PDF

 

ALL FORMS UPDATED FOR SY 2014-2015

 Requesting Eligibility Information

Form Name Format
Reimbursement Rates PDF  
Media/Press Release PDF Word
Requesting Common Logon Permissions for NSLP/Direct Certification PDF  
Electronic and Scanable Household Application Checklist PDF  
Application for free and reduced-price meals (English) PDF Word
Application for free and reduced-price meals (Spanish) PDF Word
Multi-use Application for free and reduced-price meals (English) PDF Word
Multi-use Application for free and reduced-price meals (Spanish) PDF Word
Parent Letter (English) PDF Word
Parent Letter (Spanish) PDF Word
Parent Letter Non-Pricing (English) PDF Word
Parent Letter Non-Pricing (Spanish) PDF Word
Special Milk Letter, pricing, No applications (English) PDF Word
Special Milk Letter, pricing, No applications (Spanish) PDF Word
Special Milk, Letter to Parents, Applications (English) PDF Word
Special Milk, Letter to Parents, Applications (Spanish) PDF Word
Civil Rights Compliance PDF Word
Non-Disabled Student Special Diet Order Form PDF Word
Disabled Student Special Diet Order Form PDF Word
Memorandum of Understanding PDF Word
Parent/Guardian Disclosure Consent
PDF Word

 

Certifying Income Eligible Children

Form Name Format
Income Guidelines PDF  
Notification of Benefits Letter, School Meals (English) PDF Word
Notification of Benefits Letter, School Meals (Spanish) PDF Word
Notification letter, Milk, Pricing (English) PDF Word
Notification letter, Milk, Pricing (Spanish) PDF Word

 

Verifying Household Applications

Form Name Format
Notification of Verification Letter, School Meals (English) PDF Word
Notification of Verification Letter, School Meals (Spanish) PDF Word
Letter of Verification Results (English) PDF Word
Letter of Verification Results (Spanish) PDF Word
Error-Prone Worksheet PDF XLS
Verification Tracking Form PDF  
Verification for Cause Tracking Form PDF  

 

Additional Program Forms

Form Name Format
After School Snack Program Site Review Form PDF Word
Summary of Meals Served Worksheet PDF Word
Active Excel Daily Edit Check Worksheet   XLS
Daily Edit Check Worksheet PDF Word
Updated On-Site Review Checklist PDF Word
Parent Letter of Non-Base Year PDF Word
Parent Letter of Non-Base Year – Spanish PDF Word
USDA Civil Rights Posters PDF  

 

Meal Pattern Related Forms

Form Name Format
Production Record (with menu contributions) PDF Word
Production Record (no menu contributions) PDF  
Production Record for Multiple Grades PDF  

For household materials in more languages:
http://www.fns.usda.gov/cnd/Application/translatedapps.html